Pathophysiologic Basis and Diagnostic Approaches for Ischemia With Non-obstructive Coronary Arteries: A Literature...

Area of Science:

• Cardiology
• Vascular Biology
• Diagnostic Imaging

Background:

• Ischemia with non-obstructive coronary arteries (INOCA) is increasingly recognized.
• INOCA has high prevalence, varied presentations, diagnostic difficulties, and poor outcomes.
• Key endotypes include coronary microvascular dysfunction and vasospastic angina.

Purpose of the Study:

• To review the pathophysiology of INOCA.
• To discuss current and emerging diagnostic strategies for INOCA.
• To enhance understanding of INOCA evaluation.

Main Methods:

• Review of invasive coronary interventional techniques for evaluating coronary flow reserve, microcirculatory resistance, and vasoreactivity.
• Assessment of non-invasive imaging modalities like echocardiography, SPECT, PET, and CMR.
• Exploration of novel diagnostic techniques such as continuous thermodilution and angiography-derived quantitative flow reserve.

Main Results:

• Invasive methods are standard for INOCA diagnosis.
• Non-invasive imaging provides valuable insights into coronary blood flow.
• Newer techniques show promise for improved INOCA assessment.

Conclusions:

• Accurate INOCA diagnosis requires comprehensive evaluation.
• Integrating invasive and non-invasive methods is crucial.
• Ongoing research into novel techniques will refine INOCA diagnostics.